Mediterranean Diet for Fatty Liver

The popular Mediterranean Diet is known for its ability to cause weight loss by focusing on high fiber and low fat foods. Research is also finding that this diet can reduce non-alcoholic fatty tissue around the liver. Learn more about the Mediterranean diet for fatty liver.

I made a comment not too long ago to a colleague of mine that I feel I am seeing incidence of elevated liver enzymes on the rise.  Perhaps you or a loved one has experienced this scenario- You get “routine” blood work done for an annual physical. Your doctor responds with your results saying your liver enzymes are “just a little bit elevated”.  Very non-specific. 

Your doctor likely does one of two things:

1) Recommends eating healthier, laying off the holiday egg nog, and repeating labs in a year to see if any improvement.

2) Does a million-dollar workup looking for potential infections, autoimmune diseases, and gets imaging of the liver. If the latter occurs, your blood tests likely (and thankfully) come back all negative, and the imaging returns reporting “fatty liver”, “steatosis” and/or “fibrosis”.  You are officially diagnosed with Non-Alcoholic Fatty Liver Disease, otherwise known as NAFLFD.  Your doctor recommends healthier eating, laying off the holiday egg nog, and repeating labs in a year to see if any improvement.  And you think to yourself, “what the heck is NAFLD and what can do I about it?”

Mediterranean Diet for Fatty Liver Disease

I recently read an article published in August 2019 in the International Journal of Environmental Research and Public Health written by Italian researches on treating NAFLD with the Mediterranean diet.  Non-Alcoholic Fatty Liver Disease is rapidly becoming one of the leading causes of cirrhosis and will likely become a leading cause for liver transplants.  Currently, about 30% of the world’s adult population suffers from NAFLD.  In sum, NAFLD is the liver’s consequence of metabolic syndrome.  Excess calories and obesity are key underlying players.  The development of NAFLD is multifactorial and includes an imbalance in triglyceride metabolism causing steatosis, insulin resistance, genetic polymorphisms, and dysregulated gut-liver axis (suboptimal microbiome, toxins, etc).

To date, there are no pharmaceuticals approved for the treatment of NAFLD.  Instead, lifestyle modifications are the gold-standard treatment.   And as it turns out, the traditional Mediterranean diet, which includes abundant amounts of vegetables, whole grains, whole fruits, olive oil, small amounts of fish, and 1-2 glasses of red wine daily, with significantly reduced amounts of meat (including poultry) and dairy, has consistently shown in trials to have positive effects on NAFLD. 

The reason for these positive effects are multifactorial, and are hypothesized to include the high amounts of polyphenols.  Polyphenols are secondary metabolites of plants.  They are the bright colors, bitter tastes, and potent odor that plants use as defense against ultraviolet radiation and pathogens.  These compounds at as potent antioxidants, helping to reduce inflammation and the oxidation of LDL cholesterol.  Inflammation and lipid oxidation are hypothesized to be critical components to the development of NAFLD. 

Interestingly, the authors go on to mention that a systematic review on the use of antioxidant supplements in both healthy subjects and those with chronic disease failed to find an association with a reduction in mortality. In fact, some studies have shown increased mortality from all cause when vitamin antioxidants were used. This really drives home the point that whole foods are a much more beneficial way to obtain your antioxidants than by simply taking a pill.  By eating whole foods, you are getting more micronutrients and better absorption of the phytocompounds.  

What is the Mediterranean Diet?

The Mediterranean Diet is a healthy eating plan that focuses on traditional, heart-healthy foods. Interest in this diet began when it was observed that those in Mediterranean countries (like Greece and Italy) had fewer deaths from coronary heart disease than those in the US and Northern Europe. Now there is a lot of research that shows a Mediterranean diet can help with weight loss, prevent heart attacks, strokes, and type 2 diabetes.

This type of diet includes:

  • Fruits & vegetables
  • Whole grains
  • Nuts, seeds, legumes
  • Potatoes, breads
  • Herbs, spices, extra virgin olive oil
  • Fish & seafood
  • Beans & eggs

You should limit dairy products and red meat while on this diet. Occasionally enjoy a glass of red wine.

As much as we all like a quality supplement to promote health, the research agrees, eating all the colors of the rainbow is truly your best medicine!

Have you tried the Mediterranean diet for fatty liver or weight loss? Let me know your thoughts!


Abenavoli L, Boccuto L, Federico A, et al. Diet and Non-Alcoholic Fatty Liver Disease: The Mediterranean Way. Int J Environ Res Public Health. 2019;16(17):3011. Published 2019 Aug 21. doi:10.3390/ijerph16173011

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